Intravenous amino acid therapy for kidney function in critically ill patients: a randomized controlled trial

Doig, Gordon S.; Simpson, F. O.; Bellomo, Rinaldo; Heighes, Philippa T.; Sweetman, Elizabeth A.; Chesher, Douglas; Pollock, Carol; Davies, Andrew R.; Botha, John; Harrigan, Peter; Reade, Michael C.

doi:10.1007/s00134-015-3827-9

Cited by 164 publications

(196 citation statements)

References 35 publications

Supporting

Mentioning

168

Contrasting

Unclassified

Order By: Relevance

“…an acute protein load [26]). Its measurement is difficult to perform in the ICU and few, if any, patients have such data available prior to an AKI event.…”

Section: Clinical Definition Of Renal Recoverymentioning

confidence: 99%

Renal recovery after acute kidney injury

et al. 2017

View full text Add to dashboard Cite

Acute kidney injury (AKI) is a frequent complication of critical illness and carries a significant risk of short- and long-term mortality, chronic kidney disease (CKD) and cardiovascular events. The degree of renal recovery from AKI may substantially affect these long-term endpoints. Therefore maximising recovery of renal function should be the goal of any AKI prevention and treatment strategy. Defining renal recovery is far from straightforward due in part to the limitations of the tests available to assess renal function. Here, we discuss common pitfalls in the evaluation of renal recovery and provide suggestions for improved assessment in the future. We review the epidemiology of renal recovery and of the association between AKI and the development of CKD. Finally, we stress the importance of post-discharge follow-up of AKI patients and make suggestions for its incorporation into clinical practice. Summary key points are that risk factors for non-recovery of AKI are age, CKD, comorbidity, higher severity of AKI and acute disease scores. Second, AKI and CKD are mutually related and seem to have a common denominator. Third, despite its limitations full recovery of AKI may best be defined as the absence of AKI criteria, and partial recovery as a fall in AKI stage. Fourth, after an episode of AKI, serial follow-up measurements of serum creatinine and proteinuria are warranted to diagnose renal impairment and prevent further progression. Measures to promote recovery are similar to those preventing renal harm. Specific interventions promoting repair are still experimental.

show abstract

“…an acute protein load [26]). Its measurement is difficult to perform in the ICU and few, if any, patients have such data available prior to an AKI event.…”

Section: Clinical Definition Of Renal Recoverymentioning

confidence: 99%

Renal recovery after acute kidney injury

et al. 2017

View full text Add to dashboard Cite

show abstract

“…A recent randomized comparison between 0.8 and 1.2 g/kg/24 h over 7 days reports improved handgrip strength and thigh muscle thickness, with a marginal difference in nitrogen balance [23]. In another study, for the purpose of preventing kidney injury, critically ill patients were randomized to receive extra intravenous amino acids, giving a comparison between 0.75 and 1.75 g/kg/24 h of protein intake [24]. The study revealed no differences between the two groups in terms of duration of renal failure or any other outcome parameters related to critical illness.…”

Section: Paucity Of Rctsmentioning

confidence: 99%

High protein intake without concerns?

et al. 2017

View full text Add to dashboard Cite

The high fashion in nutrition for the critically ill is to recommend a high protein intake. Several opinion leaders are surfing on this wave, expanding the suggested protein allowance upwards. At the same time, there is no new evidence supporting this change in recommendations. Observational data show that in clinical practice protein intake is most often far below current ESPEN recommendations of 1.2–1.5 g/kg/day. Therefore, it may be in the best interests of our patients just to adhere to that guideline, and not to stretch them upwards for protein intake? Here we give arguments to stay conservative.

show abstract

“…Davies et al published a meta-analysis that did not demonstrate any impact on mortality of the amount of proteins delivered to critically ill patients. A multicenter RCT found that supplemental amino acid intake added to standard nutrition compared to standard nutrition alone did not affect the duration of renal dysfunction [11], but did increase estimated glomerular fraction rate and daily urine output. Though the data on protein and calorie delivery are intriguing, the optimal calorie and protein supply at the acute phase of severe critical illness remains unknown.…”

mentioning

confidence: 99%